CATEGORY 106 AUSTRALASIAN DENTIST LINICAL The Bravo capsule is a wireless capsulebased pHmonitoring device that is inserted during endoscopy and clipped onto the wall of the oesophagus to monitor reflux episodes over 48 hours (Fig.7). It is catheter free, so better tolerated by patients. Its disadvantage is that it involves an endoscopic procedure and either sedation or a general anaesthetic procedure to insert Restech Dx-pH Measurement System is a minimally invasive form of pH monitoring that involves a shorter catheter which extends to the back of the soft palate to measure the pH (acidity) of the upper airway and oesophagus. It is a useful device for assessment of LPR and oro-pharyngeal reflux that may affect the dentition. The system can detect reflux events that occur in the upper airway, which may contribute to respiratory symptoms such as coughing, hoarseness, and wheezing. Restech also offers other diagnostic and monitoring tools for GERD and LPR, including the Restech Alkaline Reflux Test (ART), which measures the pH of saliva to determine the presence of alkaline reflux, and the Restech NightWatch, which is a wearable device that measures respiratory and acid reflux events during sleep. Recently a simple salivary biomarker test called Peptest was introduced into Australia and New Zealand to assess pepsin – the principal acid protease in the stomach. Pepsin is present in all refluxate in contrast to other gastric components such as acid or bile acids. It is an attractive noninvasive test for patients with suspected acid erosion as a result of GERD or LPR4. It is sold as a consumer product direct to patients, or a healthcare provider businessbusiness option. u Pepsin analysis can be performed on samples of saliva and sputumwhich are easily obtainable non-invasively u Pepsin is considered as a sensitive and specific biomarker for GERD, LPR and respiratory disease associated with reflux. Patients use a take-home kit to collect three saliva samples over the course of 24 hours. These are couriered to a testing laboratory which prepares a report providing a pepsin intensity scale in ng/ ml, offering a quantitative analysis and signalling the need for intervention. In addition to pH monitoring tests, other tests may be used to diagnose reflux, including oesophageal manometry, which measures the strength and coordination of the muscles in the oesophagus, and upper endoscopy, which allows the doctor to examine the oesophagus and stomach for signs of damage or inflammation. The choice of test will depend on the patient’s symptoms, medical history, and other factors, and should be determined by a healthcare professional. Gastroesophageal contributors to tooth wear are a fascinating area of dentistry and an awareness of their role is an important part of assessing cases exhibiting some form of tooth wear. u References 1. Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ. Prevalence and clinical spectrum of gastroesophageal reflux: a populationbased study in Olmsted County, Minnesota. Gastroenterology. 1997 May;112(5):1448Ð56. 2. Cho YS, Choi MG, Jeong JJ, Chung WC, Lee IS, Kim SW, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea. Am J Gastroenterol. 2005 Apr;100(4):747Ð53. 3. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Group GC. The Montreal Definition and Classification of Gastroesophageal Reflux Disease: A Global Evidence-Based Consensus. Off J Am Coll Gastroenterol ACG [Internet]. 2006 Aug [cited 2021 Jul 10];101(8):1900Ð20. Available from: https://journals.lww.com/ ajg/Abstract/2006/08000/The_Montreal_ Definition_and_Classification_of.33.aspx 4. Zhang, M., Chia, C., Stanley, C., Phyland, DJ and Paddle, PM. (2020). Diagnostic utility of salivary pepsin as compared with 24-Hour dual pH/Impedance probe in laryngopharyngeal reflux. DOI:10.1177/0194599820951183. – Google Search [Internet]. [cited 2023 Feb 26]. To find out more about tooth wear, and its comprehensive management, Dr Andrea Shepperson offers 6 month mentoring programmes covering a full curriculum, including the restorative management of tooth wear. The programme involves Online Learning via webinar, one:one mentoring with Dr Andrea Shepperson and 2 x 3-day hands on events at the Shepperson Centre on Waiheke Island, New Zealand. To find out more go to: https://www.andreashepperson. com/managing-tooth-wear/ To access the Downloadable PDF Erosion Checklist form, go to: https://mailchi.mp/ c09c8d9548f9/webinars-and-resources 1800 806 450 www.amalgadent.com.au SANDBLASTING EQUIPMENT SALE Visit our booth #265 SEE BACK COVER FOR OFFER! Footer Ads #97.indd 3 19/01/2023 6:37:41 PM Figure 7: Bravo capsule for catheter-free impedance and pH testing.
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